Healthcare Provider Details

I. General information

NPI: 1437418209
Provider Name (Legal Business Name): JESSICA L. BROWN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2012
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 PARK ROWE AVE SUITE 200
BATON ROUGE LA
70810-1686
US

IV. Provider business mailing address

PO BOX 98509
BATON ROUGE LA
70884-9509
US

V. Phone/Fax

Practice location:
  • Phone: 225-769-2200
  • Fax: 225-768-2185
Mailing address:
  • Phone: 225-769-2200
  • Fax: 225-769-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number307769
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number920
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberMP.000027
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: